Cervical Spine Anatomy and Clinical Evaluation

Orthopedic Assessment III ² Head, Spine, and Trunk with Lab PET 5609C

Clinical Anatomy 

Cervical Spine: 

Greatest range of motion 

risk of injury Smaller than other vertebral sections 7 vertebrae: 
 

Vertebral bodies:  

1st ² Atlas 2nd ² Axis

Clinical Anatomy 

Cervical Spine: 

Atlas: 
  

No vertebral body Transverse processes No true spinous process Supports the weight of the skull through 2 facet surfaces (atlanto-occipital (atlantojoint or C0-C1 C0articulation)  

Flexion and extension (primary movement) Lateral flexion (slight)

Clinical Anatomy 

AtlantoAtlanto-occipital joint dislocation: 
 

(15% of all fatal spinal trauma) MOI: high speed motor accident; Pt. unconscious at the scene, respiratory arrest en route to hospital Lateral cervical spine radiograph: 


Prevertebral soft-tissue softswelling (white arrow) Malalignment between the skull and the cervical spine with widening of the atlantoatlanto-occipital joints (black arrow)

Clinical Anatomy  Cervical Spine:  Axis:   2nd cervical vertebrae Small body with a superior projection (Dens) Dens and atlas articulation Rotation of the skull  AtlantoAtlanto-axial joint:   .

Clinical Anatomy  Cervical ligaments:  Anterior and posterior longitudinal ligaments:  Limit extension and flexion Limits flexion Between spinous processes Limit flexion and rotation Connect laminae Limits flexion and rotation   Ligamentum nuchae:  Interspinous ligaments:    Ligamentum flavum:   .

Clinical Anatomy  Brachial Plexus: C5 ² T1   7 cervical vertebrae 8 cervical nerves:   1st 7: exit above the corresponding vertebrae C8: exits below the 7th cervical vertebrae .

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Clinical Anatomy  Muscular Anatomy: Cervical extension and flexion bilateral contraction of cervical muscles  Side bending and rotation unilateral contraction  Superficial cervical musculature:  Splenius capitis  Splenius cervicis  Upper trapezius  Sternocleidomastoid  .

extension  Splenius cervicis:    .Clinical Anatomy  Splenius capitis:    O: Lower half of ligamentum nuchae I: Mastoid process and adjacent occipital bone A: Lateral bending O: C7 spinous process through T6 I: Transverse processes of C2 ² C4 A: Rotation.

Clinical Anatomy  Upper trapezius:    O: Occipital protuberance. upper portion of ligamentum nuchae I: Lateral 1/3 of clavicle. cervical spine bending. acromion process A: Cervical extension. nuchal line. upward scapular rotation . scapular elevation.

transverse processes of C1 through C4 I: Superior medial border of scapula A: Extension of cervical spine.Clinical Anatomy  Levator scapulae:    O: Spinous process of C7. scapular elevation and downward rotation .

Clinical Anatomy  Scalenes:  Anterior scalene:   O: Anterior portion of transverse processes C3-C6 C3I: Sternal attachment of 1st rib O: Anterior portion of transverse processes C2-C7 C2I: Lateral to insertion of anterior scalene on 1st rib O: Anterior portion of transverse processes C5-C6 C5I: Medial portion of 2nd rib  Middle scalene:    Posterior scalene:    Action: Lateral bending of cervical spine .

Clinical Anatomy .

lateral bending . rotation to opposite side. superior sternum I: Mastoid process A: Flexion of cervical spine.Clinical Anatomy  Sternocleidomastoid:    O: Medial clavicular head.

chronic. facet syndrome Trauma to cervical nerve root or spinal cord  Radiating pain:   Onset of pain:  Acute. vertebral fracture. ligament sprain.Clinical Evaluation  History:  Location of pain:  Localized pain:  Muscle strain. insidious .

Clinical Evaluation  History:  Mechanism of Injury:   Insidious onset:  Overuse and postural conditions Axial load (compression fracture) Flexion (compression of anterior vertebral body and intervertebral disc. posterior muscle strain) Extension (compression of posterior vertebral body and intervertebral disc. facet joint sprain. anterior longitudinal ligament sprain) Lateral bending (nerve root compression. facet joint compression) Acute onset:     .

moving spine may or pain Previous injury Scar tissue formation Injured disc Osteophyte within intervertebral foramina  Consistency of pain:    History:     .Clinical Evaluation  History:  Mechanism of Injury:  Acute onset:  Rotation (disc trauma. nerve compression): varies in intensity.e. ligament sprain. vertebral dislocation) Inflammatory induced pain: consistent pain Mechanical pain (i.

pressure on nerve roots away from the bend  .Clinical Evaluation  Inspection:  Cervical curvature: Lordotic curvature ² normal  Lateral bending posture .

Clinical Evaluation  Inspection:  Position of head on the shoulders:   Unilateral spasm ² lateral flexion of head towards involved side Torticollis: Wry neck   Rotation of chin opposite the side of the tilt Congenital or acquired spasm of the SCM .

A tight SCM muscle causes head tilt towards the tight side with rotation of the chin to the opposite side .Clinical Evaluation  Inspection:  Position of the head on the shoulders: Torticollis 18 years age male with congenital torticollis with the left SCMM tight as a band unabeling him to turn his head to the right Infant with torticollis: The attitude of the head and neck results from a combination of head tilt and rotation.

Clinical Evaluation  Inspection:  Bilateral soft tissue comparison:  Trapezius and other musculature:  Hypertrophy. atrophy  Level of the shoulders:    Height of acromioclavicular joints Deltoids Clavicles .

Clinical Evaluation  Palpation:  Anterior Structures:  Hyoid bone:   Have patient swallow noting superior and inferior movement Level of 3rd cervical vertebrae Adam·s apple Level of 4th and 5th cervical vertebrae Level of 6th cervical vertebrae  Thyroid cartilage:    Cricoid cartilage:  .

Clinical Evaluation  Palpation:  Anterior structures:  Sternocleidomastoid:  Have patient rotate head Posterior to SCM (C3(C3C6 level)  Scalenes:    Carotid artery Lymph nodes .

Clinical Evaluation  Palpation:  Posterior and Lateral Structures:    Occiput and superior nuchal line Transverse processes Spinous processes:   Have patient flex ccspine C7 and T1  Trapezius .

Clinical Evaluation  Range of Motion:  Active neck flexion and extension: Test position: patient can be standing or seated  Motion: Atlanto-occipital joint Atlanto Flexion: patient touches chin to chest (450)  Extension: patient looks up towards ceiling (450)   Active neck lateral flexion: Test position: patient seated or standing  Patient takes ear to shoulders (450)  .

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Clinical Evaluation  Range of Motion:  Active rotation: Test position: patient seated. head held upward and facing forward  Patient attempts to look over each shoulder  Motion: Atlanto-axial joint (450) Atlanto .

head off end of table  ATC: grasp patient·s head and move into extension  .Clinical Evaluation  Range of Motion:  Passive flexion: Patient position: supine  ATC: grab patient·s head (under occiput) and attempt to bring chin to chest   Passive extension: Patient position: supine.

head in neutral position  ATC: one hand under occiput. tilt head/neck to bring ear to shoulder   Passive rotation: Patient position: supine  ATC: grasp patient·s forehead and occiput. rotate head and neck  .Clinical Evaluation  Range of Motion:  Passive lateral flexion: Patient position: supine.

Clinical Evaluation .

Clinical Evaluation  Range of Motion:  Resisted range of motion: Flexion Patient: supine with cervical spine and head in neutral position  Stabilization: superior aspect of sternum  Resistance: to the forehead  Muscles tested: SCM and anterior scalenes  .

Clinical Evaluation  Range of Motion:  Resisted range of motion: Extension Patient: prone with cervical spine and head in neutral position  Stabilization: superior aspect of thoracic spine  Resistance: to the skull over the occiput  Muscles tested: trapezius (upper 1/3. cervical paraspinal muscles)  . levator scapulae.

scalenes. paraspinal muscles on the side being tested  .Clinical Evaluation  Range of Motion:  Resisted range of motion: Lateral flexion Patient: seated with cervical spine and head in neutral position  Stabilization: over the AC joint on the side toward the motion  Resistance: over the temporal and parietal bones on the side toward the motion  Muscles tested: SCM.

multifidus.Clinical Evaluation  Range of Motion:  Resisted range of motion: Rotation Patient: seated with cervical spine and head in neutral position  Stabilization: over the anterior shoulder on the side toward the rotation  Resistance: over the temporal bone on the side toward the motion  Muscles tested: SCM. rotators  .

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wrist extension Elbow extension. ER Elbow flexion.Clinical Evaluation C1C1-C2 C3 C4 C5 C6 C7 C8 T1 Neck flexion Neck lateral flexion Shoulder shrug Shoulder abduction. wrist flexion Thumb extension Finger abduction and adduction .

Clinical Evaluation  Neurological Screening:    Nerve root: C5 (Biceps brachii) Patient: seated and relaxed ATC: thumb placed over biceps tendon. strike the thumb nail with reflex hammer .

Clinical Evaluation  Neurological Screening:    Nerve root: C6 (Brachioradialis) Patient: seated and relaxed ATC: taps the brachioradialis with reflex hammer .

tap the triceps tendon with reflex hammer .Clinical Evaluation  Neurological Screening:    Nerve root: C7 (Triceps) Patient: seated and relaxed ATC: support arm in position of extension and abduction.

this reflex should cease quickly after birth . However.Clinical Evaluation  Babinkski Test:       Athlete: Supine with shoes and socks removed ATC: At the foot of the athlete holding a blunt tool Procedure: ATC runs the tool up bottom of athlete·s foot starting at the calcaneus and ending at the great toe Positive test: Great toe extends while other toes splay Implications: Lesion of upper motor neurons. may be caused by trauma to the brain Comments: This reflex occurs naturally in newborns.

Clinical Evaluation  Oppenheim Test: Test: Upper motor neuron lesions  Patient position: supine  ATC: at patient·s side  Procedure: examiner·s fingernail is run along the crest of the anteromedial tibia  Positive test: great to extends and the other toes splay  .

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